S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1641
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2021
                                ___________
 
 Introduced by M. of A. CAHILL, WALLACE -- Multi-Sponsored by -- M. of A.
   ENGLEBRIGHT,  GALEF,  PERRY -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law,  in  relation  to  requiring  certain
   health  insurance  policies  to  cover costs for scalp hair prosthesis
   worn for hair loss suffered as a result of alopecia  areata,  alopecia
   totalis or alopecia universalis
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
 amended by adding a new paragraph 36 to read as follows:
   (36)  (A)  A GROUP HEALTH PLAN, AND A HEALTH INSURANCE ISSUER OFFERING
 HEALTH INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN,  SHALL
 PROVIDE  COVERAGE FOR SCALP HAIR PROSTHESIS FOR A PARTICIPANT OR BENEFI-
 CIARY WHO HAS SCALP HAIR LOSS AS A RESULT OF ALOPECIA  AREATA,  ALOPECIA
 TOTALIS  OR  ALOPECIA  UNIVERSALIS  IF  THE  ATTENDING  PHYSICIAN OF THE
 PARTICIPANT OR BENEFICIARY CERTIFIES IN WRITING THE MEDICAL NECESSITY OF
 THAT PROPOSED COURSE OF REHABILITATIVE TREATMENT.
   (B) AS USED IN  THIS  PARAGRAPH,  THE  TERM  "SCALP  HAIR  PROSTHESIS"
 INCLUDES ANY ARTIFICIAL SUBSTITUTES FOR SCALP HAIR.
   (C)  THE  COVERAGE  REQUIRED  UNDER  THIS  PARAGRAPH IS NOT SUBJECT TO
 DOLLAR LIMITS, DEDUCTIBLES, AND COINSURANCE  PROVISIONS  THAT  ARE  LESS
 FAVORABLE  THAN  THOSE  FOR  OTHER PROSTHESIS COVERAGE UNDER THE PLAN OR
 COVERAGE, EXCEPT THAT A GROUP HEALTH PLAN OR HEALTH INSURANCE ISSUER MAY
 PROVIDE THAT THE PLAN OR ISSUER WILL ONLY PAY FOR EIGHTY PERCENT OF  THE
 CUSTOMARY  AND USUAL COSTS OF THE SCALP HAIR PROSTHESIS EXCLUSIVE OF ANY
 DEDUCTIBLE.
   § 2. Subsection (k) of section 3221 of the insurance law is amended by
 adding a new paragraph 22 to read as follows:
   (22) (A) A GROUP HEALTH PLAN, AND A HEALTH INSURANCE  ISSUER  OFFERING
 HEALTH  INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01639-01-1

 A. 1641                             2
 
 PROVIDE COVERAGE FOR SCALP HAIR PROSTHESIS FOR A PARTICIPANT OR  BENEFI-
 CIARY  WHO  HAS SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA, ALOPECIA
 TOTALIS OR ALOPECIA  UNIVERSALIS  IF  THE  ATTENDING  PHYSICIAN  OF  THE
 PARTICIPANT OR BENEFICIARY CERTIFIES IN WRITING THE MEDICAL NECESSITY OF
 THAT PROPOSED COURSE OF REHABILITATIVE TREATMENT.
   (B)  AS  USED  IN  THIS  PARAGRAPH,  THE  TERM "SCALP HAIR PROSTHESIS"
 INCLUDES ANY ARTIFICIAL SUBSTITUTES FOR SCALP HAIR.
   (C) THE COVERAGE REQUIRED UNDER  THIS  PARAGRAPH  IS  NOT  SUBJECT  TO
 DOLLAR  LIMITS,  DEDUCTIBLES,  AND  COINSURANCE PROVISIONS THAT ARE LESS
 FAVORABLE THAN THOSE FOR OTHER PROSTHESIS COVERAGE  UNDER  THE  PLAN  OR
 COVERAGE, EXCEPT THAT A GROUP HEALTH PLAN OR HEALTH INSURANCE ISSUER MAY
 PROVIDE  THAT THE PLAN OR ISSUER WILL ONLY PAY FOR EIGHTY PERCENT OF THE
 CUSTOMARY AND USUAL COSTS OF THE SCALP HAIR PROSTHESIS EXCLUSIVE OF  ANY
 DEDUCTIBLE.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ss) to read as follows:
   (SS) (1) A GROUP HEALTH PLAN, AND A HEALTH INSURANCE  ISSUER  OFFERING
 HEALTH  INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL
 PROVIDE COVERAGE FOR SCALP HAIR PROSTHESIS FOR A PARTICIPANT OR  BENEFI-
 CIARY  WHO  HAS SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA, ALOPECIA
 TOTALIS OR ALOPECIA  UNIVERSALIS  IF  THE  ATTENDING  PHYSICIAN  OF  THE
 PARTICIPANT OR BENEFICIARY CERTIFIES IN WRITING THE MEDICAL NECESSITY OF
 THAT PROPOSED COURSE OF REHABILITATIVE TREATMENT.
   (2)  AS  USED  IN  THIS  SUBSECTION,  THE TERM "SCALP HAIR PROSTHESIS"
 INCLUDES ANY ARTIFICIAL SUBSTITUTES FOR SCALP HAIR.
   (3) THE COVERAGE REQUIRED UNDER THIS  SUBSECTION  IS  NOT  SUBJECT  TO
 DOLLAR  LIMITS,  DEDUCTIBLES,  AND  COINSURANCE PROVISIONS THAT ARE LESS
 FAVORABLE THAN THOSE FOR OTHER PROSTHESIS COVERAGE  UNDER  THE  PLAN  OR
 COVERAGE, EXCEPT THAT A GROUP HEALTH PLAN OR HEALTH INSURANCE ISSUER MAY
 PROVIDE  THAT THE PLAN OR ISSUER WILL ONLY PAY FOR EIGHTY PERCENT OF THE
 CUSTOMARY AND USUAL COSTS OF THE SCALP HAIR PROSTHESIS EXCLUSIVE OF  ANY
 DEDUCTIBLE.
   §  4. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply accord-
 ing to its terms to all policies,  contracts  and  certificates  issued,
 renewed, modified, altered or amended on or after such effective date.